The PERRLA medical abbreviation means pupils equal, round, and reactive to light and to accommodation. It is a quick way to record that both pupils looked and behaved normally during an eye or nerve exam.
Each letter stands for one thing the examiner checked, which makes PERRLA a small checklist in a single word. It shows up in physical exams, emergency notes, neuro checks and eye sections of a HEENT exam. Below, each letter is explained, along with the shorter PERRL, how the test is done, and what it means when a note records something different.
At a glance
Stands for
Pupils equal, round, reactive to light and accommodationWritten as
PERRLA, PERRL, PERLAWhere you see it
Physical exams, neuro checks, emergency and ICU notesSpecialty
Nursing, emergency medicine, neurology, eye careOften paired with
EOMI, extraocular movements intactRelated scale
GCS for level of consciousness
Letter by letter: the PERRLA medical abbreviation
| Letter | Stands for | What the examiner looks at |
|---|---|---|
| P | Pupils | The black centers of both eyes |
| E | Equal | Both pupils are about the same size |
| R | Round | Each pupil has a smooth, circular edge |
| R | Reactive to | The pupils change size in response to a trigger |
| L | Light | Both pupils get smaller when light shines in |
| A | Accommodation | The pupils narrow when the eyes focus on something close |
A note that says PERRLA claims that all six parts were checked and were normal.
PERRL medical abbreviation and other short forms
PERRL drops the A, meaning pupils equal, round and reactive to light. Many busy clinicians write PERRL because they shone a light but did not test focusing on a near object. Some teachers point out that writing PERRLA when accommodation was not tested overstates the exam, so PERRL is the more honest choice in that case.
You may also see PERLA, with one R, which means the same thing as PERRLA. Neuro check sheets often skip the letters entirely and record each pupil's size in millimeters and its reaction as brisk, sluggish or nonreactive.
How the pupil check is done
The examiner first looks at both pupils in normal room light to compare size and shape. Next, a penlight is brought in from the side toward one eye, and both pupils should narrow. The light is then swung to the other eye. To test accommodation, the person looks at a far wall and then at a finger or pen held close to the nose. The eyes turn inward and the pupils shrink as they focus.
A neuro check entry: "Pupils 3 mm, PERRL, brisk bilaterally." Both pupils measure about 3 millimeters, they are equal and round, and they react quickly to light. Accommodation was not recorded.
When the pupil exam is not normal
A note may record unequal pupils, a pupil that reacts slowly, or one that does not react at all. Unequal pupil size is called anisocoria. A small difference can be normal in some healthy people, while a new or large difference, especially after a head injury, needs prompt attention from a clinician.
Many things change pupils besides illness. Eye drops used for exams, some medicines, previous eye surgery and artificial lenses can all affect size or reaction. That is why the full picture, not the pupils alone, guides decisions.
PERRLA in nursing and student charting
Nurses check pupils as part of routine assessments and more often for patients with head injuries, strokes or after brain surgery. A change from the last check is reported, and charting it with times makes trends easy to see. Students learn PERRLA alongside the Glasgow Coma Scale and EOMI, which together give a fast view of the nervous system.
Other short forms used in exams and handoffs are gathered in the nursing abbreviations page.
This page covers a pupil finding in broad terms. Your own exam results are best explained by whoever performed the check.
Frequently asked questions
What are the six parts of PERRLA?
The letters cover the pupils being equal, round and reactive, both to light and to accommodation. Together they record a normal pupil exam.
What is the difference between PERRL and PERRLA?
PERRL leaves out accommodation. It means the pupils are equal, round and reactive to light, but the near focus test was not documented.
What does accommodation mean in PERRLA?
Accommodation is the eye's ability to focus on a near object. When it works normally, the pupils get smaller as the eyes look at something close.
Is PERRLA always checked in a physical exam?
Not always. It is common in emergency, neurological and eye exams, but a routine visit for another problem may not include a pupil check.